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Total body irradiation using volumetric modulated arc therapy, experience of a cancer hospital in Pakistan

Published online by Cambridge University Press:  01 August 2022

Tabinda Sadaf Open the ORCID record for Tabinda Sadaf [Opens in a new window] ,
Asma Rashid ,
Waqas Imam Bokhari ,
Eileen Samuel ,
Aqueel Shahid ,
Raheel Mukhtar ,
Umair Zafar  and
Khalid Iqbal
Tabinda Sadaf*
Affiliation:
Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore 54000, Pakistan
Asma Rashid
Affiliation:
Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore 54000, Pakistan
Waqas Imam Bokhari
Affiliation:
Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore 54000, Pakistan
Eileen Samuel
Affiliation:
Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore 54000, Pakistan
Aqueel Shahid
Affiliation:
Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore 54000, Pakistan
Raheel Mukhtar
Affiliation:
Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore 54000, Pakistan
Umair Zafar
Affiliation:
Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore 54000, Pakistan
Khalid Iqbal
Affiliation:
Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore 54000, Pakistan
*
Author for correspondence: Tabinda Sadaf, Shaukat Khanum Memorial Cancer Hospital and Research Centre, MA R3 Johar Town Lahore, Lahore 54000, Pakistan. E-mail: tabinds@skm.orgpk
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Abstract

Introduction:

To report the planning parameters, efficacy and toxicity of total body irradiation using volumetric modulated arc therapy (VMAT).

Methods:

From July 2019 till May 2021, nine patients treated with VMAT-based total body irradiation as a part of the myeloablative regimen for homologous stem cell transplant were evaluated. The CT acquisition, planning parameters, doses to target volume and critical structures were evaluated retrospectively.

Results:

Median age was 24 with median height 172 cm. Average Mean Lung dose was 9·5 Gy, mean dose to kidney was kidney dose 8·4 Gy, planning target volume (PTV) 95% was 98 % and mean heterogeneity index of PTV was 1·2 all patients. Total fraction delivery time including setup was 3·1 h while beam on time was 23 min. Main toxicity observed was mucositis and fatigue, while no Grade 3 or more acute radiation toxicity was observed.

Conclusion:

At our institution, high dose TBI performed with multi-isocentric VMAT is now a standard procedure. Though it is cumbersome and time-consuming process but VMAT offers an advantage of increased dose homogeneity in the target volume with reduction in doses to critical organs especially lungs and kidneys in comparison to standard source to skin distance technique, longer follow-up time is necessary to evaluate our method and long-term toxicity.

Keywords

Total body irradiation (TBI)Volumetric modulated arc therapy (VMAT)Organs at risk (OAR)
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 22 , 2023 , e40
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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References

Sabloff, M, Tisseverasinghe, S, Babadagli, ME, Samant, R. Total body irradiation for hematopoietic stem cell transplantation: what can we agree on? Curr Oncol 2021; 28 (1): 903–917. https://doi.org/10.3390/curroncol28010089 CrossRefGoogle Scholar
Sorror, ML, Storer, BE, Maloney, DG, Sandmaier, BM, Martin, PJ, Storb, R. Outcomes after allogeneic hematopoietic cell transplantation with nonmyeloablative or myeloablative conditioning regimens for treatment of lymphoma and chronic lymphocytic leukemia. Blood 2008; 111 (1): 446–452.CrossRefGoogle ScholarPubMed
Abugideiri, M, Nanda, RH, Butker, C et al. Factors influencing pulmonary toxicity in children undergoing allogeneic hematopoietic stem cell transplantation in the setting of Total body irradiation based Myeloablative conditioning. Int J Radiat Oncol Biol Phys 2016; 94: 349–359.Google ScholarPubMed
Giebel, S, Miszczyk, L, Slosarek, K, Moukhtari, L, Ciceri, F, Esteve, J Extreme heterogeneity of myeloablative total body irradiation techniques in clinical practice: a survey of the acute leukemia working party of the European group for blood and marrow transplantation. Cancer 2014; 120: 2760–2765.CrossRefGoogle ScholarPubMed
Kelsey, CR, Horwitz, ME, Chino, JP et al. Severe pulmonary toxicity after myeloablative conditioning using total body irradiation: an assessment of risk factors. Int J Radiat Oncol Biol Phys 2011; 81: 812–818.CrossRefGoogle ScholarPubMed
Depledge, MH, Barrett, A, Powles, RL. Lung function after bone marrow grafting. Int J Radiat Oncol Biol Phys 1983; 9 (2): 145–151.CrossRefGoogle ScholarPubMed
Pinnix, CC, Smith, GL, Milgrom, S et al. Predictors of radiation pneumonitis in patients receiving intensity modulated radiation therapy for Hodgkin and non-Hodgkin lymphoma. Int J Radiat Oncol Biol Phys 2015; 92: 175–182.CrossRefGoogle ScholarPubMed
Gogna, NK, Morgan, G, Downs, K, Atkinson, K, Biggs, J. Lung dose rate and interstitial pneumonitis in total body irradiation for bone marrow transplantation. J Med Imaging Radiat Oncol 1992; 36 (4): 317–320.Google ScholarPubMed
Kim, TH, Khan, FM, Galvin, JM et al. Total body irradiation conference: a report of the work party: comparison of total body irradiation techniques for bone marrow transplantation. Int J Radiat Oncol Biol Phys 1980; 6: 779–784.CrossRefGoogle ScholarPubMed
Wolden, SL, Rabinovitch, RA, Bittner, NHJ et al. American College of Radiology (ACR) and American Society for Radiation Oncology (ASTRO) practice guideline for the performance of total body irradiation (TBI). Am J Clin Oncol: Cancer Clin Trials 2013; 36: 97–101.Google ScholarPubMed
Labar, B, Bogdanic, V, Nemet, D et al. Total body irradiation with or without lung shielding for allogeneic bone marrow transplantation. Bone Marrow Transplant 1992; 9: 343–347.Google ScholarPubMed
Ekstrand, K, Greven, K, Wu, Q. The influence of X-ray energy on lung dose uniformity in total-body irradiation. Int J Radiat Oncol Biol Phys 1997; 38: 1131–1136.CrossRefGoogle ScholarPubMed
Ravichandran, R, Binukumar, JP, Davis, CA et al. Simple technique for fabrication of shielding blocks for total body irradiation at extended treatment distances. J Med Phys 2009; 34: 223–225.CrossRefGoogle ScholarPubMed
Sun, R, Cuenca, X, Itti, R et al. First French experiences of total body irradiations using helical TomoTherapy. Cancer Radiother 2017; 21: 365–372.CrossRefGoogle ScholarPubMed
Zhuang, AH, Liu, A, Schultheiss, TE et al. Dosimetric study and verification of total body irradiation using helical tomotherapy and its comparison to extended SSD technique. Med Dosim 2010; 35: 243–249 CrossRefGoogle ScholarPubMed
Hui, SK, Karaptoes, J, Fowler, J et al. Feasibility study of helical tomotherapy for total body or total marrow irradiation. Med Phys 2005; 32: 3214–3224.CrossRefGoogle ScholarPubMed
Springer, A, Hammer, J, Winkler, E et al. Total body irradiation with volumetric modulated arc therapy: dosimetric data and first clinical experience. Radiat Oncol 2016; 11: 1–9.CrossRefGoogle ScholarPubMed
Dominello, MM, Kaufman, I, McSpadden, E, Snyder, M, Zaki, M, Maier, J. Target Volume Heterogeneity Index, a potentially valuable Metric in IMRT prostate cancer treatment planning. J Nucl Med Radiat Ther 2014; 5: 4.CrossRefGoogle Scholar
Commission on Radiation Units and Measurements. Report 83. Prescribing, Recording, and Reporting Photon-Beam Intensity-Modulated Radiation Therapy (IMRT). Oxford: Oxford University Press, 2010.Google Scholar
Girinsky, T, Benhamou, E, Bourhis, JH et al. Prospective randomized comparison of single dose versus hyperfractionated total body irradiation in patients with hematologic malignancies. J Clin Oncol 2000; 18: 9816.CrossRefGoogle ScholarPubMed
Weiner, RS, Bortin, MM, Gale, RP et al. Interstitial pneumonitis after bone marrow transplantation. Assessment of risk factors. Ann Intern Med 1986; 104: 168–175.CrossRefGoogle ScholarPubMed
Sampath, S, Schultheiss, T, Wong, J. Dose response and factors related to interstitial pneumonitis after bone marrow transplant. Int J Radiat Oncol Biol Phys 2005; 63: 876–884.CrossRefGoogle ScholarPubMed
Ozsahin, M, Pene, F, Touboul, E et al. Total-body irradiation before bone marrow transplantation. Results of two randomized instantaneous dose rates in 157 patients. Cancer 1992; 69: 2853–2865.3.0.CO;2-2>CrossRefGoogle ScholarPubMed
Sampath, S, Schultheiss, TE, Wong, J. Dose response and factors related to interstitial pneumonitis after bone marrow transplant. Int J Radiat Oncol Biol Phys 2005; 63: 876–884.CrossRefGoogle ScholarPubMed
Gao, R, Weisdorf, D, DeFor, T et al. Influence of total body irradiation dose rate on idiopathic pneumonia syndrome in acute leukemia patients undergoing allogeneic hematopoietic cell transplantation. Int J Radiat Oncol Biol Phys 2019; 103: 180–189.CrossRefGoogle ScholarPubMed
Cheng, J, Scheltheiss, T, Wong, J. Impact of drug therapy, radiation dose, and dose rate on renal toxicity following bone marrow transplantation. Int J Radiat Oncol Biol Phys 2008; 71: 1436–1443.CrossRefGoogle ScholarPubMed
Ouyang, L, Folkerts, M, Zhang, Y et al. Volumetric modulated arc therapy based total body irradiation: workflow and clinical experience with an indexed rotational immobilization system. Phys Imaging Radiat Oncol 2017; 4: 22–25.CrossRefGoogle Scholar
Tas, B, Durmus, IF, Okumus, A et al. Total-body irradiation using linac-based volumetric modulated arc therapy: its clinical accuracy, feasibility, and reliability. Radiother Oncol 2018; 129 (3): 527–533.CrossRefGoogle ScholarPubMed
Springer, A, Hammer, J, Winkler, E et al. Total body irradiation with volumetric modulated arc therapy: dosimetric data and first clinical experience. Radiat Oncol 2016; 11: 46.CrossRefGoogle ScholarPubMed
Kirby, N, Held, M, Morin, O, Fogh, S, Pouliot, J. Inverse-planned modulated-arc total body irradiation. Med Phys 2012; 39: 2761–2764.CrossRefGoogle ScholarPubMed
Chretien, M, Cote, C, Blais, R et al. A variable speed translating couch technique for total body irradiation. Med Phys 2000; 27: 1127–1130.CrossRefGoogle ScholarPubMed
Jahnke, A, Jahnke, L, Molina-Duran, F et al. Arc therapy for total body irradiation–a robust novel treatment technique for standard treatment rooms. Radiother Oncol 2014; 110: 553–557.CrossRefGoogle ScholarPubMed